The Frequency and Distribution of Unexpected Antibodies in Surgical Patients at Chonbuk National University Hospital / 대한진단검사의학회지

BACKGROUND: Unexpected antibody screening and identification tests using a column agglutination method are very important in elective surgical patients. We compared the frequency and distribution of unexpected antibodies in our elective surgical patients with other results. METHODS: We analyzed the results from 6, 500 antibody screening tests performed for elective surgical patients at Chonbuk National University Hospital during the recent five-year period. Screening and identification of unexpected antibodies were carried out using a column agglutination method with the DiaMed-ID system (DiaMed, Cressier, Morat, Switzerland). RESULTS: Unexpected antibodies were detected from 42 samples (0.64%) out of all 6, 500 samples. Clinically significant antibodies were found in 0.32% of all the population. Of these, 13 samples showed anti-E, 3 samples showed anti-E+c, 3 samples showed anti-D, 1 sample showed anti-Fyb and another one sample showed anti-Kpa. CONCLUSION: The results of frequency and distribution of unexpected antibodies in Chonbuk National University Hospital were not different from others. We have verified that the antibody screening and identification test using the column agglutination technique would have had a higher detection rate for clinically relevant antibodies such as anti-Rh antibodies than other methods.

A case of Small Colony Variants (SCVs) of Staphylococcus aureus from Sputum of a Patient with Chronic Renal Failure / 대한임상미생물학회지

Recently, small colony variants (SCVs) of Staphylococcus aureus causing fatal infections are increasing, but rarely reported in Korea. S. aureus, SCVs are slow growing subpopulation that cause persistent and relapsing infections. S. aureus, SCVs are frequently auxotrophic for hemin, menadione, and CO2, and are often disrupted in their electron transport activity. With S. aureus, SCVs virulence is altered by a decrease in -toxin production and susceptibility to various antibiotics, allowing their intracellular survival. We isolated S. aureus, SCVs from the sputum of a 67 year old male with pneumonia, chronic renal failure with hemodialysis and preventive antibiotic therapy. Because S. aureus, SCVs are easily missed or misdiagnosed as normal flora in routine culture due to their atypical growth behavior and biochemical reaction, the correct identification is very important, especially when no bacteria or unusual bacteria are found in patients with persistent or relapsing infections with long term antibiotic therapy.

Two cases of partial-D showing different reactivity to various anti-D reagents / 대한수혈학회지

The 19-year-old twin sisters donated their blood in 2000. Their blood had typical Rh D negative red cell phenotype in Rh typing and weak D test using an anti-D reagent (Dade Behring, USA). Twin sisters donated blood again in 2001. Both were negative in anti-D reagent (Bioscotte Ltd., UK) and weakly positive in additively performed weak-D test. So we have acquired blood samples from them for further study in 2002. The red blood cells from twin sisters were not agglutinated with 4 various commercially available anti-D reagents. But in subsequently performed weak-D test, different reactivity to their anti-D reagents were shown, namely negative (Dade Behring, USA) and weakly positive (Ortho-clinical diagnostics, USA; Greencross, Korea; Bioscotte Ltd., UK). The lack of reactivity with some anti-D as shown in these cases can indicate the presence of a partial D antigen. So we carried out a additional serologic test using 6 monoclonal anti-D antibodies in partial-D typing set (Diamed, Switzerland) on Rh D antigens of red cells from twin sisters. According to the different reactivity patterns, we confirmed elder sister was partial-D category DFR and younger sister was partial-D with indeterminate category.

The Influence of Antimicrobial Abuse to Blood Culture / 대한임상미생물학회지

BACKGROUND: Blood culture has been used for finding the etiology of bacteremia. The results of its susceptibility test can be an important tool for deciding the direction of treatment. However, the rate of positive blood culture is very low; it, most of all, is because of the abuse of antimicrobials. Especially under the condition which allows anyone to get antimicrobials at any pharmacies and hospitals without antimicrobial susceptibility test as in Korea, the abuse of antimicrobials be brought about, but there is no concrete information about it. METHODS: The rate of antimicrobial abuse and the serum antimicrobial activities of 106 patients, whose blood was requested for diagnosis of bacteremia, were investigated, and the results were compared with blood culture results. Thirteen mililiters of blood was as eptically extracted; 10 ml out of it was used for blood culture and the serum separated from 3ml of blood was used for serum antibacterial activities. For the test of serum antimicrobial activities, standard strain of bacteria, Staphylococcus aureus ATCC 25923, which are susceptible to every antibiotics was used. And for the blood culture, blood samples were inoculated to aerobic and anaerobic culture broth, and incubated in the automated blood culture system. The abuse of antimicrobials were investigated by the interview with patients and the medical records at admission. RESULTS: The antimicrobial abuse rate was 78.3%(83/106), and the rate of positive blood culture was as low as 6.6%(7/106). The rate of positive serum antibacterial activity was 47.2%(50/106). The rate of positive blood culture in the group of positive serum antimicrobial activity was only 4%(2/50) and that in the group of negative serum antimicrobial activity was 8.9%(5/56). And in the group of positive blood culture, the rate of positive serum antimicrobial activity was 28.6%(2/7) and the rate of negative activity was 71.4%(5/7). CONCLUSIONS: The antimicrobial abuse rate in Korea was considerably high, and the rate of positive blood culture was very low. The rate of positive blood culture in the group of positive serum antibacterial activity was conspicuously lower than that in the group of negative ones. According to these results, the use of antimicrobials before blood culture should be carefully considered for the diagnosis and treatment of bacterial infection.

A Case of Lactate Dehydrogenase-IgGk, lambda Complex in Angioimmunoblastic Lymphadenopathy with Dysproteinemia / 대한임상병리학회지

There are various complex formations between immunoglobulin and serum enzymes in the body. Of these, LD-Immunoglobulin complex is most common. It has reported that LD-IgG or LD-IgA complex existed in the serum of healthy person or many patients who have various clinical disorders. The clinical significance of complexes is not known, but it results in the increase of total LD activity and interference to the LD isoenzyme electrophoresis interpretation due to its anomalous pattern. We have reported a case of LD-Immunoglobulin complex in AILD(Angioimmunoblastic lymphadenopathy with dysproteinemia) with reference. The patient was admitted with fever, chills and cervical LN enlargement, in LN biopsy, diagnosed AILD, and during treatment expired by sepsis. Since admission, serum total LD activities were increased and serum LD isoenzyme EP showed that LD3-5 fractions was not separated in broad single band. Its pattern was due to LD-immunoglobulin complex, LD-bound immunoglobulin was IgG ,lamda. For the identification of immunoglobulin, we at first did serum protein immunoelectrophoresis. then stained the plate with tetrazolium dye for LD activity.

Three Rho(D) negative siblings from Rho(D) Positive Parents / 대한수혈학회지

The authors have experienced 3 Rho(D) negative siblings from Rho(D) positive parents. ABO grouping and typing were carried out because the parents wanted their and children's blood types. On the five major Rh antigen(D, C, c, E, e) testing, the phenotypes of the both parents were CcDe, and those of their 3 siblings were cde. We can suspect the possible genotypes on the basis of the frequencies in Korean, both parents are CDe/cde and their 2 daughters and one son are cde/cde.